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Graft-Versus-Host Disease

Tacrolimus + Mycophenolate Mofetil Post Transplant (FHCRC-1898)

A Multi-Center Study of Nonmyeloablative Conditioning with TBI or Fludarabine/TBI for HLA-matched Related Hematopoietic Cell Transplantation for Treatment of Hematologic Malignancies with Post Grafting Immunosuppression with Tacrolimus and Mycophenolate Mofetil

RATIONALE: Giving low doses of chemotherapy, such as fludarabine, and radiation therapy before a donor stem cell transplant helps stop the growth of cancer cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune system and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving tacrolimus and mycophenolate mofetil after transplant may stop this from happening.

PURPOSE: This phase II trial is studying how well giving tacrolimus together with mycophenolate mofetil works in preventing graft-versus-host disease in patients who have undergone total-body irradiation with or without fludarabine followed by donor stem cell transplant for hematologic cancer.

Less than 6 months duration of a complete remission (CR) between courses of conventional therapy

Mantle cell NHL

May be in first CR

Chronic lymphocytic leukemia

Meets one of the following criteria:

Failed to meet NCI Working Group criteria for complete or partial response OR relapsed within 12 months after completion of prior fludarabine-containing regimen (or another nucleoside analog [e.g., cladribine or pentostatin])

Failed FLU-CY-Rituximab (FCR) combination chemotherapy at any time point

Have "17p deletion" cytogenetic abnormality (patients should have received induction chemotherapy but could be transplanted in 1st CR)

Hodgkin's lymphoma

Failed prior front-line therapy AND failed or not eligible for autologous transplantation

Multiple myeloma

Undergone autograft or equivalent high-dose therapy without a graft OR failed after prior autograft

Acute myeloid leukemia

Less than 5% marrow blasts

No circulating leukemic blasts in the peripheral blood

Acute lymphoblastic leukemia (ALL)

Less than 5% marrow blasts

No circulating leukemic blasts in the peripheral blood

Chronic myelogenous leukemia (CML) OR myeloproliferative disorders

Less than 5% marrow blasts

No circulating leukemic blasts in the peripheral blood

Myelodysplastic syndromes

Less than 5% marrow blasts

Waldenstrom Macroglobulinemia

Must have failed 2 courses of therapy

Not eligible for conventional allogeneic HSCT

Patients who are ineligible for active disease-specific protocols OR unable to be enrolled in FHCRC-1813.00 are allowed

Not eligible for high-priority curative autologous transplantation

Refused treatment on a conventional HSCT protocol

Disease expected to be stable for ≥ 100 days without chemotherapy

HLA-matched related donor available, meeting the following criteria:

Genotypically identical for ≥ 1 haplotype

Phenotypical or genotypically identical at the allele level at HLA-A, -B, -C, -DRB1, and -DQB1

12 years of age or older

Not an identical twin

No rapidly progressive aggressive NHL, unless in minimal disease state

No CNS involvement refractory to intrathecal chemotherapy NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. However, this protocol uses the former terminology.